Laparoscopic gastric plication versus mini-gastric bypass surgery in the treatment of morbid obesity: A randomized clinical trial

This prospective, randomized trial compared the safety and effectiveness of laparoscopic Roux-en-Y gastric bypass (LRYGBP) and laparoscopic mini-gastric bypass (LMGBP) in the treatment of morbid obesity. LRYGBP has been the gold standard for the treatment of morbid obesity. While LMGBP has been reported to be a simple and effective treatment, data from a randomized trial are lacking. Eighty patients who met the NIH criteria were recruited and randomized to receive either LRYGBP (n = 40) or LMGBP (n = 40). The minimum postoperative follow-up was 2 years (mean, 31.3 months). Perioperative data were assessed. Late complication, excess weight loss, BMI, quality of life, and comorbidities were determined. Changes in quality of life were assessed using the Gastro-Intestinal Quality of Life Index (GIQLI). There was one conversion (2.5%) in the LRYGBP group. Operation time was shorter in LMGBP group (205 versus 148, P < 0.05). There was no mortality in each group. The operative morbidity rate was higher in the LRYGBP group (20% versus 7.5%, P < 0.05). The late complications rate was the same in the 2 groups (7.5%) with no reoperation. The percentage of excess weight loss was 58.7% and 60.0% at 1 and 2 years, respectively, in the LPYGBP group, and 64.9% and 64.4% in the LMGBP group. The residual excess weight <50% at 2 years postoperatively was achieved in 75% of patients in the LRYGBP group and 95% in the LMGBP group (P < 0.05). A significant improvement of obesity-related clinical parameters and complete resolution of metabolic syndrome in both groups were noted. Both gastrointestinal quality of life increased significantly without any significant difference between the groups. Both LRYGBP and LMGBP are effective for morbid obesity with similar results for resolution of metabolic syndrome and improvement of quality of life. LMGBP is a simpler and safer procedure that has no disadvantage compared with LRYGBP at 2 years of follow-up.

Background: Laparoscopic gastric plication (LGP) is emerging as a safe and effective bariatric procedure. A comparative study between the efficacy and complications of LGP with modified enteric bypass and LGP with loop bipartition, which are still an investigational bariatric procedure. The objective of this study to compare safety and efficacy of LGP with enteric bypass and LGP with loop bipartition in the treatment of morbid obesity in a one-year follow-up study. Methods: A prospective study between February 2016 to December 2017, conducted on 80 morbid obese patients who were candidates for laparoscopic gastric plication, with either loop bipartition or modified enteric bypass surgery were randomly assigned to receive either LGP modified enteric bypass (n = 40) or LGP with loop bipartition (n = 40). Early and late complications, body mass index (BMI), excess weight loss, and obesityrelated co-morbidities were determined at the 1-year follow-up. Results: Operative time and mean length of hospitalization were shorter in the LGP with modified enteric bypass group than LGP with loop bipartition; (110 minutes versus 120 minutes, P<.001, and 2 days versus 3 days; P<.001, respectively). The mean percentage of excess weight loss (%EWL) at 12 months follow-up was (79.5%) in the LGB with modified enteric bypass group and (74.1%) in the LGP group (P = 0.03). Improvement was observed in all co-morbidities in both groups. Conclusion: Both LGP and LGB are effective weight loss procedures. LGP enteric bypass proved to be a simpler and less costly procedure compared with LGP with loop bipartition with a lower risk of stomal ulcer during one year follow up.

Background Laparoscopic mini-gastric bypass (MGBP) is gaining popularity among the bariatric procedures today, and laparoscopic sleeve gastrectomy (SG) as a single-stage procedure for the treatment of morbid obesity is becoming increasingly popular. Patients and methods Between October 2016 and July 2018, 50 obese patients were randomized, operated upon, and followed up for 12 months in Al Zahraa Hospital and Shebin El-Kom teaching Hospital. A total of 25 patients underwent SG, and 25 patients underwent MGBP. The mean BMI of all patients was 47.8 ± 5.5 kg/m2, their mean age was 30 ± 8.3 years, and 80% of them were female. Patients were followed up at 1, 3, 6, 9, and 12 months. Operative time, length of hospital stays, weight loss, comorbidity improvement or resolution, postoperative complications, reinterventions, and mortality were evaluated. Results Age, sex, BMI, and comorbidities were equal. The mean operative time for SG was 86.9 ± 51.6 min and that for MGBP was 108.4 ± 41.8 min; the percentage of 1-year excess weight loss was similar (76.2 ± 4.49% for SG and 80.3 ± 8.3% for MGBP). The comorbidities were significantly improved after both procedures, except for type 2 diabetes mellitus, which showed a higher resolution rate after MGBP. Conclusion Laparoscopic SG regarding excess weight loss is comparable to laparoscopic MGBP in short-term follow-up (1 year) with less metabolic effect. Further long-term studies are needed.

Objective: The aim of this study was to compare the results of the Roux-en-Y gastric bypass (RYGB) and mini-gastric bypass (MGB) regarding postoperative gastro-esophageal reflux disease (GERD), as well as safety and efficacy. Patients and Methods: This prospective study included 60 morbidly obese adults scheduled for bariatric surgery, randomly divided into two groups according to the type of bariatric procedure; MGB ( n = 30) and RYGB group ( n = 30). GERD symptoms were recorded using the GERD score questionnaire. Follow-up included evaluation of weight loss and GERD, upper gasrointestinal endoscopy to assess biliary reflux, and condition of the stomach and esophagus. Results: The operative time was significantly longer in RYGB group compared to MGB group ( p &lt; 0.001). The percentage of excess weight loss was slightly higher in the MGB group after 6 months ( p = 0.096). There were no cases of leakage or mortalities in the two groups. Complications were recorded in 30% of the MGB group and 40% of the RYGB group. Biliary reflux was detected endoscopically in 11 patients (36.6%) in the MGB group and none of the RYGB group. GERD symptoms were exaggerated in MGB group after 1 month compared to RYGB group ( p = 0.008). At 12 months, symptoms improved significantly in the two groups; the scores were nonsignificantly higher in MGB group ( p = 0.088). Esophagitis was more common in the MGB group than RYGB group ( p = 0.008). Conclusion: Laparoscopic Roux-en-Y gastric bypass and laparoscopic mini-gastric bypass appear to be equally effective in the treatment of morbid obesity regarding weight loss and resolution of obesity-related metabolic complications. On short-term follow-up, MGB exaggerated GERD symptoms, but in the long run, symptoms decreased markedly.

Has mini gastric bypass come of age?

BackgroundLaparoscopic Roux-en-Y gastric bypass (LRYGB) is considered the gold standard in bariatric surgery, achieving durable long-term weight loss with improvement of obesity-related comorbidities. Lately, the laparoscopic mini gastric bypass (LMGB) has gained worldwide popularity with similar results to LRYGB in terms of weight loss and comorbidity resolution. However, there is a lack of randomized controlled trials (RCT) comparing LMGB and LRYGB. This article describes the design and protocol of a randomized controlled trial comparing the outcomes of these two bariatric procedures.Methods/DesignThe trial is designed as a single center, randomized, patient and observer blinded trial. The relevant ethics committee has approved the trial protocol. To demonstrate that LMGB is not inferior to LRYGB in terms of excess weight loss (EWL) the study is conducted as a non-inferiority trial with the sample-size calculations performed accordingly. EWL 12 months after surgery is the primary endpoint, whereas 3-year EWL, morbidity, mortality, remission of obesity related comorbidities, quality of life (QOL) and hormonal and lipid profile changes are secondary endpoints. Eighty patients, 18 years or older and with a body mass index (BMI) between 35 and 50 kg/m2 who meet the Swiss guidelines for the surgical treatment of morbid obesity will be randomized. The endpoints and baseline measurements will be assessed pre-surgery, peri-surgery and post-surgery (fixed follow up measurements are at discharge and at the time points 6 weeks and 12 and 36 months postoperatively).DiscussionWith its 3-year follow up time, this RCT will provide important data on the impact of LMGB and LRYGB on EWL, remission of comorbidities, QOL and hormonal and lipid profile changes.Trial registrationClinicalTrials.gov, NCT02601092. Registered on 28 September 2015.

Bariatric surgery is an effective treatment for morbid obesity and its metabolic related comorbidities; type 2 diabetes, hypertension and hyperlipidaemia.1 However, the literature is scarce regarding the long-term outcome after bariatric surgery, especially among multi-ethnic Asian populations. Considering the growing number of bariatric metabolic surgeries in Asia, we have attempted to provide a regional perspective on 5-year long-term clinical outcomes post bariatric surgery in Singapore. Between 2010 and 2016, all bariatric operative cases were included, and these comprised: laparoscopic sleeve gastrectomy (LSG), 393; laparoscopic Roux-En-Y gastric bypass (RYGB), 125; laparoscopic mini-gastric bypass (MGB), 43. The primary outcome measure was the percentage of excess weight loss (% EWL) at 6 months, 1, 2, 3, 4 and 5 years, with % remission of type 2 diabetes mellitus (T2DM) at 1 year following LSG (49.7%, 61.2%, 56.1%, 47.8%, 40.8% and 47.3%; 82.2%), RYGB (60.2%, 62.1%, 57.6%, 50.1%, 48.7% and 47.7%; 86.9%) and MGB (58%, 68.1%, 62.7%, 66.2%, 64.0%, 65.2%; 71.9%). In conclusion, MGB and RYGB showed the greatest % EWL at 5 years and are recommended for moderate T2DM. LSG is an effective bariatric operation with a high % EWL up to 2 years, and a high remission rate of mild T2DM. The remission rate of T2DM was equally high in all 3 surgical groups, independent of ethnic differences.

Background:The laparoscopic mini-gastric bypass is a newly emerged surgical procedure in recent years. Owe to safe and simple process and effective outcomes, laparoscopic mini-gastric bypass has quickly become one of the most popular procedures in some countries. The safety and effectiveness of laparoscopic mini-gastric bypass versus laparoscopic sleeve gastrectomy remain unclear.Methods:A systematic literature search was performed in PubMed, Embase, Cochrane library from inception to May 20, 2017. The methodological quality of Randomized Controlled Trials and non-Randomized Controlled Trials were, respectively, assessed by Cochrane Collaboration's tool for assessing risk of bias and Newcastle–Ottawa scale. The meta-analysis was performed by RevMan 5.3 software.Results:Patients receiving mini-gastric bypass had a lot of advantageous indexes than patients receiving sleeve gastrectomy, such as higher 1-year EWL% (excess weight loss), higher 5-year EWL%, higher T2DM remission rate, higher hypertension remission rate, higher obstructive sleep apnea (OSA) remission rate, lower osteoarthritis remission rate, lower leakage rate, lower overall late complications rate, higher ulcer rate, lower gastroesophageal reflux disease (GERD) rate, shorter hospital stay and lower revision rate. No significant statistical difference was observed on overall early complications rate, bleed rate, vomiting rate, anemia rate, and operation time between mini-gastric bypass and sleeve gastrectomy.Conclusion:Mini-gastric bypass is a simpler, safer, and more effective bariatric procedure than laparoscopic sleeve gastrectomy. Due to the biased data, small sample size and short follow-up time, our results may be unreliable. Large sample and multicenter RCT is needed to compare the effectiveness and safety between mini-gastric bypass and sleeve gastrectomy. Future study should also focus on bile reflux, remnant gastric cancer, and long term effectiveness of mini-gastric bypass.

To evaluate the short-term outcome of laparoscopic gastric bypass on obesity patients with type 2 diabetes mellitus. Seven obesity patients with type 2 diabetes mellitus received laparoscopic gastric bypass(n=1) or laparoscopic minigastric bypass(n=6), and their data of treatment outcomes were analyzed. The operations were all successfully performed without any complications. The average operation time was 125 minutes(range: 100 to 170 minutes). The patients underwent 1-18 months follow-up after operation. Diabetic indicators returned to normal without any medication and body weight reduced by on average of 24.3 kg. Laparoscopic gastric bypass and minigastric bypass have good short-term outcome in the treatment of obesity patients with type 2 diabetes mellitus.

Purpose: The laparoscopic mini gastric bypass (LMGB) is purportedly a technically simpler, yet equally effective operation to the laparoscopic Roux‐en‐Y gastric bypass as treatment for morbid obesity. This study reports the early results of LMGB in a major New Zealand bariatric centre.Methodology: Clinical data was prospectively collected on all patients undergoing LMGB over a two year period.Results: 142 patients were studied. 77% were females. Mean age was 43.8. Pre‐operative mean body weight and body mass index (BMI) were 121.3 kg and 45.4 kg/m2 respectively. Mean BMI at one and two years follow up had decreased to 27.35 and 25.72 kg/m2 respectively. 83% of patients reported obesity associated co‐morbidities pre‐operatively. Post‐operatively, 78% of patients reported a reduction in medication requirement. All surgery was performed laparoscopically. There were no anastomotic leaks and zero mortality. 8% of patients required further operations for complications or revision to a Roux‐en‐Y gastric bypass. 20% of patients required subsequent endoscopic interventions, the majority for investigation of vomiting and/or pain. 22% of patients required re‐admission. 14% of patients reported new onset reflux or worsening of pre‐existing reflux after LMGB. 82% of patients reported increased exercise capability post LMGB. 54% of patients required vitamin supplementation.Conclusion: LMGB achieves significant weight loss and resolution of obesity related co‐morbidities with a low short term complication rate. LMGB should be considered as a safe and simple surgical option for morbid obesity.

Le mini-gastric bypass coelioscopique : une option nouvelle pour le traitement de l’obésité morbide

Aim Bariatric surgery is the most effective long-term obesity treatment. We aim to compare laparoscopic sleeve gastrectomy (LSG) and laparoscopic mini gastric bypass (LMGB) as surgical interventions for morbid obesity, focusing on postoperative weight loss patterns, complications, and long-term efficacy. Method The review synthesizes findings from a comprehensive literature analysis, including retrospective and prospective studies, clinical trials, and meta-analyses. Data were evaluated regarding excess body weight loss (EBWL), complication rates, and postoperative outcomes associated with LSG and LMGB. The technical aspects and physiological effects of both procedures were also assessed. Results Both LSG and LMGB demonstrated effective short- and medium-term outcomes in terms of weight loss and remission of obesity-related comorbidities. LSG resulted in 47–76% EBWL within 1–2 years, with sustained long-term results showing &amp;gt;50% EBWL at 5 years in many studies. LMGB showed comparable or slightly higher EBWL, averaging 65–91% at 1–2 years and 80% at 5 years in some reports. LSG had fewer complications such as nutritional deficiencies but higher incidence of gastroesophageal reflux disease (GERD). LMGB had low rates of bile reflux and marginal ulcers, and showed high patient satisfaction, with shorter operation time and reversibility as added benefits. Conclusions Both LSG and LMGB are effective bariatric procedures for morbid obesity, offering significant weight loss and improvement in comorbidities. While LSG is technically simpler and safer with fewer nutritional deficiencies, LMGB provides slightly superior long-term weight outcomes and patient satisfaction. The choice of procedure should be individualized based on patient risk profile, comorbid conditions, and lifestyle adaptability.

Background: Obesity is one of the important chronic diseases with high growth in worldwide and bariatric surgery is currently considered the most effective treatment for weight reduction. Objectives: We aimed to analyze weight loss follow up and diabetes management in patients submitted to mini gastric bypass on use of vitamin and mineral supplementation, in the new set up center, in Mazandaran province for the first time. Methods: Prospective analysis of 27 volunteers of both sexes, aged between 23 - 52 years, using laparoscopic mini gastric bypass in Sari’s Avicenna hospital, were included; personal information, anthropometric and laboratory data in the preoperative, 3, 6 and 9 months were collected. Statistical analysis was done with SPSS, 19 and using the Wilcoxon and Friedman test. Results: During follow up time after 276 days mean weight decreased from 118.7 ± 23.3 to 82.9 ± 15.7, P < 0.001 BMI also changed from 45.2 ± 1.8 to 32.2 ± 1.3, P < 0.001. There was decrease in percentage of excess weight loss at month of 3, 6 and 9 were 52.1, 32.6 and 16.4 respectively. Fasting blood sugar in diabetic subjects (n = 16) decreased from 170.9 ± 84.5 to 89.8 ± 11.3, P = 0.04. Conclusions: In the newly set up center similar to the older one, surgical treatment in our follow up duration was effective for reducing weight, body mass index reduction and achievement of success in biochemical markers on diabetics.

Introduction Roux-en-y gastric bypass is a successful weight loss surgery together with a great impact on metabolic syndrome. Laparoscopic minigastric bypass is a new emerging bariatric surgery procedure with current debates on its efficacy and safety. Objectives The aim of this study was to evaluate the effect of laparoscopic minigastric bypass on weight loss, safety, and associated metabolic diseases. Patients and methods The study was performed in Menoufia University Hospital and other private hospitals in Kuwait. All patients underwent laparoscopic minigastric bypass and were followed up for 18 months. Its impact on BMI, %excess weight loss (%EWL), and associated metabolic diseases were reported and analyzed at 6, 12, and 18 months. Results A total of 80 patients were included in this study, of whom 49 were female. A total of 58 patients were diabetic, 62 patients were hypertensive, and 69 patients were dyslipidemic. The mean operative time was 92 ± 11.73 min. The mean %EWL was 77.3 ± 9.8%. The mean hospital length of stay was 3 days. One patient had anastomotic leak and two patients had biliary gastritis and were managed with Roux-en-Y gastric bypass. One patient showed marginal ulcer. A total of 47 patients with type 2 diabetes returned to normal glucose level. A total of 51 hypertensive patients became normotensives. A total of 59 patients showed complete improvement in lipid profile after 18 months. Conclusion Minigastric bypass is provisionally effective as other standard bariatric surgery procedures, with good impact on associated metabolic diseases.

Background: Obesity is known to be an increasing health concern recently in both developed and developing countries. Its medical importance peaked after been recognized globally as a disease of its own in addition to being a major predisposing factor for chronic diseases. Obesity is now increasing in prevalence in adults, adolescents, and children, and is now considered to be a global epidemic. Surgical treatment for obesity in the form of bariatric and metabolic operations has revolutionized our approach in treating obesity and prevent/treat its complications. Laparoscopic mini-gastric bypass operation emerged recently among bariatric operations and proved itself as an efficient and safe operation. Aim: To evaluate the ability of laparoscopic mini-gastric bypass in reducing weight among obese patients. Subjects and Methods: A sample of 40 individuals with a body mass index (BMI) greater than 35 kg/m2 was randomly selected from the obesity clinic, Suez Canal University teaching hospital, city of Ismailia, Egypt. The patients underwent laparoscopic mini-gastric bypass operation and were offered a follow up for a period of 12 months. Results: The mean BMI of the patients declined from 49.2 kg/m2 preoperatively to 34.2 kg/m2 at the end of the follow-up. This was associated with a dramatic increase in the mean percent excess body weight loss (%EWL) from 20% early postoperatively to 71% at the end of follow up (p <0.05). There was no mortality among the patients and the complications were minimal and self-limiting. Conclusions: Laparoscopic mini-gastric bypass had proved itself to be a safe and effective operation in reducing weight.